Ozeki I, Abe T, Sakai H, Suwa T, Masukawa J, Yonezawa K, Tosaka M, Ikeda Y, Akaike J, Hosokawa A, Itoh Y, Takagi H, Hiura K, Tago H, Imai K
Department of Internal Medicine, Gastroenterology and Rheumatology, Kushiro City General Hospital.
Ryumachi. 1998 Jun;38(3):523-8.
A case of intestinal perforation associated with SLE is presented. A 54-year-old woman was diagnosed as having SLE twenty-five years ago when she had facial erythema, photosensitivity, oral aphtha, polyarthraliga, leukopenia, positive LE cell and positive antinuclear antibody. She had been treated with prednisolone and admitted to Kushiro City General Hospital because of one month history of fever and anorexia in February 1996. Laboratory findings did not reveal activity of SLE, and a diagnosis of urinary tract infection was made based on the findings of urinalysis. After severe diarrhea, disseminated intravascular coagulation (DIC) developed. A rectal perforation was revealed by endoscopic and radiological examination. An emergency laparotomy revealed necrosis of the rectum and sigmoidostomy was performed. The biopsied specimen of the rectum were diagnosed as gangrene of ischemic colitis histologically. Because of a penetration to the urinary bladder, an ureterocutaneostomy was performed. She died of sepsis and DIC on the 127th day of admission. Only 11 cases of intestinal perforation associated with SLE have been reported in Japan, and the association of vasculitis has been considered. In the present case, the prolonged use of prednisolone might cause the necrotizing ischemic colitis.
本文报告一例与系统性红斑狼疮（SLE）相关的肠穿孔病例。一名54岁女性在25年前被诊断为SLE，当时她有面部红斑、光敏性、口腔溃疡、多关节痛、白细胞减少、LE细胞阳性和抗核抗体阳性。她曾接受泼尼松龙治疗，并于1996年2月因持续一个月的发热和厌食症入住钏路市综合医院。实验室检查未发现SLE活动迹象，根据尿液分析结果诊断为尿路感染。严重腹泻后，发生了弥散性血管内凝血（DIC）。内镜和放射学检查发现直肠穿孔。急诊剖腹手术显示直肠坏死，并进行了乙状结肠造口术。直肠活检标本经组织学诊断为缺血性结肠炎坏疽。由于直肠穿孔累及膀胱，进行了输尿管皮肤造口术。她在入院第127天死于败血症和DIC。在日本，仅报告了11例与SLE相关的肠穿孔病例，并且考虑到了血管炎的关联。在本病例中，长期使用泼尼松龙可能导致坏死性缺血性结肠炎。
